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Fatal doxepin intoxication--suicide or slow gradual intoxication?
M A Neukamm1, S Vogt, M Hermanns-Clausen
1Institute of Legal Medicine, University Medical Center, Albertstrasse 9, D-79104 Freiburg im Breisgau, Germany. merja.neukamm@uniklinik-freiburg.de
Abstract:
The differentiation of intoxication courses is one of the most difficult challenges for forensic pathologists and toxicologists. The case of a 52-year-old female inpatient of a psychiatric clinic with multiple medications who died from doxepin intoxication is reported. Concentrations of doxepin metabolites and isomers, pharmacokinetic modelling and genotyping of the doxepin-metabolizing cytochrome P450 (CYP) enzymes led to the following conclusion: the lethal doxepin concentration of 2100 ng/mL was more likely to have been reached due to drug interactions and genetic peculiarities leading to a reduction of the metabolic capacity and not by an acute (suicidal) overdose.
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